618. DO CLINICAL FACTORS AFFECT MICROBIAL ENGRAFTMENT AFTER FECAL MICROBIOTA TRANSPLANTATION IN RECURRENT CLOSTRIDIUM DIFFICILE INFECTION?
Session: Poster Abstract Session: Microbiome and Beyond
Thursday, October 4, 2018
Room: S Poster Hall

Background:

Fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection (rCDI). Few studies have evaluated clinical factors associated with microbial engraftment. We describe microbial changes post-FMT and clinical factors impacting engraftment.

Methods:

Patients undergoing FMT for rCDI via colonoscopy were enrolled. Clinical data and stool were collected pre- and 8 weeks post-FMT. Microbial profiles were assessed by 16S rRNA sequencing. Difference in microbial alpha and beta-diversity between groups was determined. Significance testing was assessed using Mann-Whitney-Wilcoxon and PERMANOVA tests. The Jensen Shannon Divergence (JSD) between donor and their recipient post-FMT was used as a measure of engraftment. The association of clinical factors on engraftment was evaluated by linear regression.

Results:

A total of 12 patients received an FMT from 12 unique donors. The efficacy rate was 92%. Mean recipient age was 60 years (range: 33-87) with more females (7/12).

Recipients pre-FMT alpha diversity was significantly lower compare to donors (p=0.04, Fig 1a). This difference dissipated post-FMT (p=0.67). On beta-diversity analysis, the recipients pre-FMT samples clustered separately from their post-FMT samples (p=0.01, Fig 1b), with the post-FMT samples shifting closer to the donor samples. Proteobacteria was dominant in patients’ pre-FMT samples and were substantially reduced post-FMT, combined with an expansion in Bacteroidetes (Fig. 2).

On linear regression analysis, clinical factors (age, sex, previous recurrent CDI episodes, inflammatory bowel disease, proton pump inhibitor, immunosuppression, previous anti-CDI antibiotic courses, probiotics) were not significantly associated with engraftment outcomes.

Conclusion:

There is a significant and durable shift in recipients’ microbial profile to resemble their donor post-FMT. Recipients’ pre-FMT clinical factors did not significantly affect microbial engraftment. Future metagenomic studies may help elucidate whether clinical factors impact engraftment.

Fig 1A: Alpha diversity

Fig 1B: Bray-Curtis Principle component plot

Fig 2: Relative abundance of taxa at Phylum level

 

Shrish Budree, MD1,2, Majdi Osman, MD MPH1, Pratik Panchal, MD3, Edina Shu, B.S.4, Madeline Carrellas, B.A.4, Zain Kassam, MD MPH5 and Jessica Allegretti, MD, MPH4, (1)OpenBiome, Somerville, MA, (2)Pediatrics, University of Cape Town, Cape Town, South Africa, (3)Clinical Research, OpenBiome, Somerville, MA, (4)Gastroenterology, Brigham and Women's Hospital, Boston, MA, (5)Finch Therapeutics, Somerville, MA

Disclosures:

S. Budree, None

M. Osman, None

P. Panchal, None

E. Shu, None

M. Carrellas, None

Z. Kassam, None

J. Allegretti, None

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